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Cashless Denial Letter

The document is a denial of cashless authorization for Claim No: 4000052757A for patient Suresh Viswanath Panchal due to a waiting period clause in the insurance policy. The claim was denied because the patient's condition falls under a specified disease waiting period of two years. The document outlines the reasons for denial and provides options for the customer to seek reconsideration or escalate the complaint.

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60 views2 pages

Cashless Denial Letter

The document is a denial of cashless authorization for Claim No: 4000052757A for patient Suresh Viswanath Panchal due to a waiting period clause in the insurance policy. The claim was denied because the patient's condition falls under a specified disease waiting period of two years. The document outlines the reasons for denial and provides options for the customer to seek reconsideration or escalate the complaint.

Uploaded by

unitedfaculties
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Cashless Denial

Date: 22-May-2023
Time: 4:39 PM
To,

Insurance Desk ,
Suyash Nursing Home
11, Seven Hill Colony, MGM Hospital
Road,Aurangabad,,AURANGABAD,AURANGABAD
,MAHARASHTRA,INDIA,431001

Dear Sir/Madam,

Subject : Denial of cashless authorization of Claim No: 4000052757A

Reference:

Patient Name SURESH VISWANATH PANCHAL


Age 48 Gender MALE
Proposer Name AXIS BANK LIMITED Relationship with Self
Proposer
Claimant UHID 0238936811/464721684/01
Policy Number 0239326260 Certificate Number 00072583
Policy Start Date 07-Mar-2023 Policy End Date 06-Mar-2024
Date of Admission 22-May-2023 Date of Discharge 25-May-2023
Preauth received Date 22-May-2023
Room Category Single Room Ac Claimed Amount 93370
Diagnosis Righat renal calculus with obstructive uropathy

We are in receipt of preauthorization request towards the above cited hospitalization. We have scrutinized the same
with reference to the policy terms and conditions and regret the inability to consider cashless benefit for the
captioned hospitalization under the policy. The reasons are mentioned below-

Rejection Reason
As per submitted documents insured got admitted for management of Right renal calculus with obstructive
uropathy. As per policy member since-07/03/2022. According to the policy wordings standard waiting period of 2
years is applicable to settle the claim for the above stated condition. Hence, we regret to inform you that cashless
facility is denied.

Sections / Clause Policy wordings


Section 3.i.1.ii / Excl 02 . Specified Disease/Procedure Waiting Period.

Please note that -:

1. The denial of cashless facility does not imply denial of treatment and does not in any way prevent the customer/

Tata AIG General Insurance Company Limited Page 1 of 2

Registered Office : Peninsula business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013. 24X7 Toll Free No: 1800 266 7780 or
1800 229 966 (For Senior Citizens) | Visit us at www.tataaig.com | IRDA of India Registration No: 108 | CIN: U85110MH2000PLC128425
patient from seeking necessary medical attention or hospitalization.
2. The cashless benefit is merely a facility extended by TATA AIG General Insurance Company and we do not
guarantee the availability, quality and outcome of the treatment, choosing of a Network or Non Network Hospital
is a prerogative of the beneficiary.
3. Customer can submit the claim for reimbursement for reconsideration.

In case if you are not satisfied in any way with our decision on claim, you may do the following:

1. For reconsideration you may contact the respective branch office of the Company or may call us at toll free no.
1800-2667780/1800229966 (for Senior Citizen) or email us at healthclaimsupport@tataaig.com or write to us at
Tata AIG Health Claims Hub, Door No. 615, 616, 5th and 6th Floor, Imperial Towers, Ameerpet, Next to Ameerpet
Metro Station, Hyderabad, Telangana - 500016.
2. If you are not satisfied with the resolution provided, you may approach us through - Grievance Redressal on our
www.tataaig.com ( Tata AIG Customer Grievance Redressal Policy )
3. In case your complaint is not fully addressed by us, you may use the Integrated Grievance Management System
(IGMS) for escalating the complaint to IRDA. Through IGMS you can register your complaint online and track its
status. For registration please visit IRDA website www.irda.gov.in.
4. If the issue still remains unresolved, you may subject to vested jurisdiction, approach Insurance Ombudsman for
the Redressal of the grievance as cited in the policy copy.

Thanking you and assuring you of our best services at all times.

Yours Sincerely,
Tata AIG General Insurance Co. Ltd.
Authorized Signatory

Tata AIG General Insurance Company Limited Page 2 of 2

Registered Office : Peninsula business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013. 24X7 Toll Free No: 1800 266 7780 or
1800 229 966 (For Senior Citizens) | Visit us at www.tataaig.com | IRDA of India Registration No: 108 | CIN: U85110MH2000PLC128425

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